Key result
Acute nitroglycerin increases aortic-brachial pulse wave velocity ratio ~9% by reducing peripheral muscular artery stiffness.
Why the study?
The pharmacological manipulation of the arterial stiffness gradient, which protects microcirculation from high pulsatile pressure, had not been thoroughly investigated.
Does acute administration of nitroglycerin alter the arterial stiffness gradient in adult subjects?
Does acute administration of nitroglycerin alter the arterial stiffness gradient in adult subjects?
Absolute Event Rate: 1.42% vs 1.3%
p-value: p=0.001
Acute administration of nitroglycerin reduces the pulse wave velocity of muscular arteries without modifying aortic PWV, creating an unfavorable arterial stiffness gradient profile.
Acute nitroglycerin may unfavorably alter stiffness gradient; leaves open outcome implications in prospective studies.
Background: Physiologically, the aorta is less stiff than peripheral conductive arteries, creating an arterial stiffness gradient, protecting microcirculation from high pulsatile pressure. However, the pharmacological manipulation of arterial stiffness gradient has not been thoroughly investigated. We hypothesized that acute administration of nitroglycerin (NTG) may alter the arterial stiffness gradient through a more significant effect on the regional stiffness of medium-sized muscular arteries, as measured by pulse wave velocity (PWV). The aim of this study was to examine the differential impact of NTG on regional stiffness, and arterial stiffness gradient as measured by the aortic-brachial PWV ratio (AB-PWV ratio) and aortic-femoral PWV ratio (AF-PWV ratio). Methods: In 93 subjects (age: 61 years, men: 67%, chronic kidney disease [CKD]: 41%), aortic, brachial, and femoral stiffnesses were determined by cf-PWV, carotid-radial (cr-PWV), and femoral-dorsalis pedis artery (fp-PWV) PWVs, respectively. The measurements were repeated 5 min after the sublingual administration of NTG (0.4 mg). The AB-PWV and AF-PWV ratios were obtained by dividing cf-PWV by cr-PWV or fp-PWV, respectively. The central pulse wave profile was determined by radial artery tonometry through the generalized transfer function. Results: At baseline, cf-PWV, cr-PWV, and fp-PWV were 12.12 ± 3.36, 9.51 ± 1.81, and 9.71 ± 1.89 m/s, respectively. After the administration of NTG, there was a significant reduction in cr-PWV of 0.86 ± 1.27 m/s ( p < 0.001) and fp-PWV of 1.12 ± 1.74 m/s ( p < 0.001), without any significant changes in cf-PWV ( p = 0.928), leading to a significant increase in the AB-PWV ratio (1.30 ± 0.39 vs. 1.42 ± 0.46; p = 0.001) and AF-PWV ratio (1.38 ± 0.47 vs. 1.56 ± 0.53; p = 0.001). There was a significant correlation between changes in the AF-PWV ratio and changes in the timing of wave reflection ( r = 0.289; p = 0.042) and the amplitude of the heart rate-adjusted augmented pressure ( r = − 0.467; p < 0.001). Conclusion: This study shows that acute administration of NTG reduces PWV of muscular arteries (brachial and femoral) without modifying aortic PWV. This results in an unfavorable profile of AB-PWV and AF-PWV ratios, which could lead to higher pulse pressure transmission into the microcirculation.
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Fortier et al. (2021) studied Chronic kidney disease and hypertension (n=93). Nitroglycerin vs. Baseline was evaluated on Aortic-brachial pulse wave velocity (AB-PWV) ratio (p=0.001). Acute administration of nitroglycerin significantly increased the aortic-brachial pulse wave velocity ratio from 1.30 to 1.42 (p=0.001) by reducing peripheral muscular artery stiffness.
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